The URL can be used to link to this page

Home My WebLink AboutPermit Mechanical 2004-08-23Building/Combination Permit PERMIT NO: COM2004-01044Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676Fax 541-7 26-37 69 Inspection Line ISSUED: APPLIED: EXPIRES: VALUE: 08t23t2004 08t23t2004 021231200s uq 2 SITE ADDRESS: 3705 VIRGINIA AVE ASSESSOR'S PARCEL NO.: 1702314304501 PROJECT DESCRIPTION: Install wood stove insert Springfield TYPE OF WORK: Wood Stove TYPE OF USE: New Owner: Address Contractor Type Mechanical Contractor KEITH LEESMAN Expiration Date 04t04t2005 Residential Phone s4t-99s-61s7 JOHNSON ROY E 3710 VIRGINIA SPRINGFIELD OR 97478 License 72082 CONTRACTOR INFORMATION aluation # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: Frontyard Setback: Side I Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Street Improvements: Storm Sewer Available: Special Instruction: Notes: Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: o/o of Lot Coverage: NOTICE: # of Stories:Lot Size: Sq Ft lst Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Occupant Load:nla DER THIS PERMIT toR-3 rules Genter is $ Per Sq Ft or multiplier ol the ruie: OAR 9t MIT SH ZED UN REQUIRED PARIflNG Total: Handicapped: Compact: Sidewalk Type: Downspouts/I)rains: RE IF THE WORK THIS PER THORI ALL EXPI IS NOl ERIOD Square Footage or Bid Amount NED FOR PUBLIC IMPROVEMENTS Description Tvpe of Construction Total Yalue of Project Value Date Calculated LH 11 U ll-l,rl1\ (, rL\ Ir (JI(lYrryJ uri\iIy are set tor11 Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676Fax 541-7 26-37 69 Inspection Line Building/Combination Permit PERMIT NO: COM2004-01044ISSUED: 0812312004APPLIED: 08/2312004 EXPIREST 0212312005 VALUE: Fees Peid Fee Description -Mechanical Issuance Fee- + l0o/o Administrative Fee + 7o/o State Surcharge Minimurn/Adj ustment Mechanical Wood Stove/Insert Total Amount Paid Amount Paid $10.00 $4.s0 $3.1s $15.00 $30.00 $62.65 Date Paid 8t23t04 8t23t04 8t23/04 8t23t04 8t23t04 Receipt Number 1200400000000001250 1200400000000001250 1200400000000001250 1200400000000001250 1200400000000001250 Plan Reviews To Request an inspection call the24 hour recording at 726-3769. AII inspection requested before 7:00 a.m. will be made the same working day, inspections requested after 7:00 a.m. will be made the following work day. Wood Burning Insert: After installation. Reouired fnsnections By signature, I state and agree, that I have carefully examined the completed application and do hereby certify that all information hereon is true and correct, and I further certify that any and all work performed shall be done in accordance with the Ordinances of the City of Springfield and the Laws of the State of Oregon pertaining to the work described herein, and that NO OCCUPANCY will be made of any structure without permission of the Community Services Division, Building Safety. I further certify that only contractors and employees who are in compliance with ORS 701.005 will be used on this project. I further agree to ensure that all required inspections are requested at the proper time, that each address is readable from the street, that the permit card is located at the front of the property, and the approved set of plans will remain on the site at all times during construction. r[^, /.4 Owner or Date Pase2 of2 IL Construction Contractors Board 700 Surnmer St NE Suite 300 PO Box 14140 Salem OR 97309-5052 Phone: 503-3784621 Web Address: www.ccb.state.or.us Pennit #: CQvta?s)O '( - O /Oq q Address:37O{ v.' Issued by:}(Date:Z v Statement: lnformation Notice to Property Owners About Construction Responsibilities Note: Oregon Law, ORS 701.055(4) requires residential construction permit applicants who are not licensed with the Construction Contractors Board to sign thefollowing statement before a building permit can be tssued. This statement is requiredfor residential building, electrical, mechanical and plumbing permits. Licensed architect and engineer applicants, exemptfrom licensing under ORS 701.010(7), need not submit this statement. This statement will befiled with the permit. Fill in the appropriate blanks and initial boxes I and 2, andeither box 3A or 38: l. I own, reside in, or will reside in the completed structure. 2. I understand that I must become licensed as a constuction conhactor if the structure is sold or offered for sale before or on completion. 3A. Mygeneral contractor is CSt rt* i-efSwt rhr/Tbaz (Name)(ccB #) I will instruct my general contactor that all subconhactors who work on the structure must be licensed with the Constnrction Contractors Board. OR tr 38. I will be my own general contactor. If I hire subcontractors, I will hire only subcontractors licensed with the Construction Contractors Board. If I change my mind and hire a general contractor, I will contract with a contractor who is licensed with the CCB and will immediately notift the office issuing this building permit of the name of the contractor. I hereby certify that the above information is correct and that I have read and do understand the Information Notice to Property Owners about Construction Responsibilities on the reverse side of this form. K d, EX r/.s /" + applicant) (White copy to issutng agency permitfile, pink copy to applicant.) @ate) Property_owner.doc 06-0 I -04 Acting as Your Own General C6'ntractor? . INFORMATION NOTICE TO PROPERTY OWNERS ABOUT CONSTRUCTION RESPONSIBILITIES Ifyou are acting as your own contractor to construct a new home or make a substantial improvement to an existing strucfure, you can prevent many problans by being aware of th-e following responsibilities and concerns Employer Responsibilities you witrI. in most instances, be ruled to be an "employer" and the coatractors you con-tract wjth will be "erqployees" if you use contaators not licensed with the Construition Contractors Board to do labor in constructing or to assist in the tonstruction or improvement of a residsntial structure. As the employer, you must comply with the following: Oregonos Withhotding Tax Law: As an employer, you must withhold income taxes from employee wages at the time "rrrploy"", are paid. fou will be liabls for the tax payments even if you don't actually withhold the tax from your employees'Formoreinformation,caIitheDepartmenttfn'"'o',.,"at503-378{988;'1 Unemployment Insurance Tax: As an employer, you are required to pay a tax for unemployment insurance pu'po'"i" onthewagesofa11employees.Formoreinformation,callthe0regonEmploymentDepartmentat503-947-l488. The Oregon Business Identification Number (Bbl) is a combined number for both Oregon Withholding and Unemp1oymentInsuranceTax.Tofi1eforaBIN,call503-945-809lorlforthe approprbteforms, : ) ) -i \'.- Workers, Compensation Insurance: As an employer, you are subject to the Oregon Workers' Compensation Law, and must.obtain workers' compensaticn insuranie for your employees. If you fail to obtain ygrker!' competrsation insurance, you could'be subjecito panalties and be liabie forall claim costs if one of yotrr en-rnlgrees.is injured on the job. For more information, call the Workers' Compensafion Division at the Depadrnent of C6nsumer and Business Services at 503-947 -7 815. U.S. Internal Revenue Service: As an employer, you must withhold federal income tax from ernployees' wages. you will be liable for the tax payment even if you didn't actualiy withhold the tax. For a Federal EIN number, call the Other Responsibilities end Areas of Concerns Code Compliance: As the permit holder for this project" you are responsible for resolving any failure to meet code reqr:iremenis that may be brought to your attention through inspections. Liability and Frope rty Damage Insarance : Co*tact yorlr insurance'agent to see if you have adequate insurance ,**r*rrgu fcr accidents and cm;siions s*ch as faltring tools, paint sver spray, water damage fiom pipe punctures, fire or work that must be rcdonc. Time: Make sure you,have sufficient time to supervise your employee$. ' i " ' 'r1" ! i1 1-" !51" ':'; Expertise: Make sure yo,, h'br. iE' skills't'd a'ct as your owii'general contractor, to coordiriate' the work of rough-in and tjnish trades, and to notify building officials as the appropriate times so they can perform the required inspections. If you have additional questions call the Construction Contractors Board (503-3784621) or write fhe agency at PO Box 14140, Salem, OR 97309*5052. ,.1-i{, )(} i,;L,.qt,,.. ,f ,:r{i"r Property_owner.doc 06-0 1 -04 NOTE: Tltis lnformation Natice to Proparty awners about Canstruction Responsibiffiies was devetoped by the Construction Contractors Board in accordance with ORS 7U.a55{5), passed by the 1989 Oregon Legislature. I | - 225 Fifth Street Springfield, Oregon 97 477 541-726-3759 Phone r='ry of Springfield Official Receipt , velopme,nt Services DePartment Public Works DePartment RECEIPT #: 1200400000000001250 Date:08/2312004 10:39:55AM Job/Journal Number coM2004-01044 coM2004-01044 coM2004-01044 coM2004-01044 coM2004-01044 Description + 7o/o State Surcharge + l0% Administrative Fee Wood Stove/Insert Minimum/Adjustment Mechanical -Mechanical Issuance Fee- Amount Due 3.15 4.50 30.00 15.00 10.00 Item Total:$62.6s Payments: Type ofPayment Check Paid By ROY JOHNSON Received By Batch Number Number How Received djb 2863 In Person Payment Total: Amount Paid $62.6s - $62.6s Check Numbei Authorization 8/23/2004 Page I of I SPEaLOllf.lo t\ 225 FIFIH STREET . SPRINGFIELD, OR 97477 o PII:(541)726-1375ll o tAX: (541)726-36E9 CityJob Number G:*rZP<>q -A lO\ 4 Job Iocation:o Assessor's Map:a Tax Lot:CqJI){ Owner: Address: 37 tO V,'-a.ir,i-Phone: ltj-- 4,33 ( . ^.g.;gtfutate: /Dn *" u tn-zip: ?7tll Y ----c City:.fn ri^. {r "( ) \a'+t 11 Preliminary Wood Contractor: Permit, Issuance Fee, State Surchalge and Administrative Fee). O ,tl Information J hx,v Con q /rr-]r r* Phone:3+f -)tozAddress: .?7t^8 Uj<.+ lt)\ (-IH Vr pr{pc () r 1-{ t-{(1,l-l(1 ,!-t dtE{crp{+J O () e"a e4F{f-{ {JL{Oa c.'1+-lF-{ () c+.)(n f Cc B Fuz-El.a, Construction ConYractor's Registration #: 72o " State: Ope-coyL zip:City: I Expires:A. By signing this pemrit / apphcation, I agree to call for an I state that all infornration on this applicationlpemrit is the Wood Stove Safety infornration for wood burning (726-3769). provided with inspection Federal approval number to the am requesting a preliminary t Et'tstandards as set by the Oregon De Environmental Protection Agency inspector at the time of inspection. I inspection, the wall covering nray be Signature:* fz= /o,Date: FOR OFHCE USE Date of Application: 8-23 ^C) Y Checked for Historical Status:Checked for Delinquencies: Shared Dlive(T:),/Building Fonns/Wood Stove Penrril 3-04-04.doc CITY OF OREGON I $c $etd t/